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Nearly three years ago, the Commonwealth of Pennsylvania took steps to develop a new approach to healthcare. Concluding that “The present system was designed to treat acute illness, not control chronic diseases,” the state established the Pennsylvania Chronic Care Management, Reimbursement and Cost Reduction Commission.

The Commission was directed to prepare a state-wide plan to improve the quality of care for patients with chronic conditions while reducing preventable illnesses and their costs. The state’s actions came as figures showed that in Pennsylvania almost 80% of healthcare costs are spent on 20% of patients who have chronic diseases.

The plan makes heavy use of clinical information systems. “A key goal is to use the power of data to improve chronic care while strengthening prevention efforts and lowering costs,” said Alisa LoSasso, MD, FAAP, Associate Professor of Clinical Pediatrics at Temple University Hospital and School of Medicine. Dr. LoSasso is overseeing Temple Pediatric Care’s participation in the plan. Over 1,100 TUH pediatric asthma patients between the ages of 5 and 18 are enrolled in the initiative, as are all the practice’s pediatricians.

“With heavy IS involvement, we can reach more patients with prevention tools. We can also uncover patterns that might otherwise go unnoticed,” said Dr. LoSasso. “We use a web-based electronic registry for a variety of activities, including sending reminders to providers and patients, identifying patient subpopulations for preventive care, developing individual patient care planning, and sharing information with providers and patients.” For example, the registry has allowed pediatricians to mail flu clinic reminders; target patients with risk factors, such as smoke exposure; and utilize pre-printed action plan forms to encourage medication use and correct dosing.

Results are encouraging. For example, across the collaborative, 60% of patients received flu shots during the 2008/2009 flu season, compared to U.S. percentages of 10-40%. Importantly, the rate of hospitalization has been reduced by 50% for asthmatic patients of Temple Pediatric Care.

In a national first, the plan includes the active involvement of insurance companies, who provide reimbursements for staff participation in special training sessions and for some clinical care. “The thinking is that everyone benefits if chronic patients get sick less often,” says Dr. LoSasso. “Naturally, patients and families are better off. There’s less demand on hospital resources, particularly for the uninsured. And payers have an incentive to support measures that lower their eventual payment obligations.”

Dr. LoSasso is pleased with the initiative’s accomplishment to date and anticipates future benefits. “By targeting our asthma patients with flu-shot reminders in a systematic way, we’ve certainly kept a lot of kids from getting sick,” she notes. “We have a number of exciting goals, including developing strategies for decreasing ER visits and rates of hospitalization as well as spreading chronic care improvements to other diagnoses such as autism and ADHD.”